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[ok]

Thanks for the pic california.

Your ankles / feet still seem a bit swollen, I hope the swelling subsides soon.

When do you expect to start walking / weight bearing?

Thanks

[California2]

The most significant hurdle I encountered during this process was edema (swelling of my feet and ankles).  I am grateful that my edema began to resolve once I stopped distraction.  It is about 80% resolved now and I am told the balance should quickly resolve once I begin walking.

I feel ready to walk now; however, I am instructed to wait until my bones are at least 75% consolidated.  My next x-ray is next week and I hope and suspect I will begin walking after that x-ray/appointment.

I am being followed by a local MD team working in consultation with Drs. Solomin and Kulesh.

[myloginacc]

For me, 10% would have been 3.7 cm.  I ended up doing about 24%.

If by "tight", you mean tight in the ankle joints or the beginnings of equinas or both, I was aware of and cautioned to train against equinas. 

Solomin & Kulesh take x-rays at every centimeter interval of lengthening.  They also perform an MD bandage change once per week.  For both tasks they take photos.  Each time they take photos, they instruct you to pull your foot up as much as possible so that they can assess and document dorsiflexion.

I recall hearing comments when distracting up to the 3 cm point like "foot position looks good--good dorsiflexion". 

After 3 cm but before 4 cm, I started getting comments like "can you pull your toes up any more?"

After 4 cm, I got a written warning that my "dorsiflexion is not excellent". 

At about 5 cm, I was advised to consider stopping distraction or doing ATL.  At this time, after stretching I could maintain neutral dorsiflexion (90 degrees).

I resisted ATL arguing that I had neutral dorsiflexion; therefore, I just needed to work hard and stretch 1 mm per day to keep pace with distraction.

After about another week, I accepted that stretching alone was not realistic--too much work and pain to keep at it for another month and, when I got honest with myself, I was not really keeping pace.

I also decided that I had not gone through this f***ing process for 2 f***ing inches.  So, I had a long talk with Dr. Kulesh about ATL and realized that most of what I thought I knew about ATL was inaccurate.  Additionally, my remaining valid concerns about possible rupture or over-lengthening/under-lengthening were addressed via Dr. Kulesh's new ATL protocol.

Once the 4th half-ring and hexapods were installed, I distracted and stretched my ATL at the same time.  I found that I could not BOTH stretch my ATL and distract at a rate of 1 MM per day so I reduced my distraction rate to .75 mm per day.

Thereafter, I continued at pretty much .75 mm per day up to essentially 9 mm but reducing the rate, taking days off, and once or twice increasing the rate, based upon what my body was telling me it would tolerate at that time.

Please let me know if the above does not fully answer your question.

It does fully answer the question - thanks a lot!

Would you say the whole journey would have been easy had you stopped at 3cm? Also, despite any increased ease, do you think such a small lengthening amount would be worth the sleepless nights and pain, depending on the height and goals of the patient?

[California2]

Please forgive in advance my long-winded response.

To me, your question involves a primarily personal decision based on personal goal and desires.

For me, I wanted to increase me height at least 3 inches and as much as 5 inches.  I originally envisioned two rounds of procedures increasing my femoral length by about 3 inches; then, coming back again and increasing my lower leg length by about 2 inches.

For me again, if I was not going to get a significant benefit from the surgery(ies); then, there was no good point in putting my body through the trauma and my life through the disruption.

So, would it be easy to stop at 3 cm?  Yes, it would be quite easy. 

But to me, the salient question is "would it be wise to put your body through the trauma of elective limb lengthening surgery and put your life through the disruption of elective limb lengthening surgery for a height gain of about one inch?"  For me, the answer is absolutely "no".

The rub becomes that most surgeons pronounce that lengthening by 10% is safe; yet, for most patients, 10% is not enough height gain nor is it enough to justify the surgery and all the surgery entails.

At the outset, Solomin agreed that I could lengthen my lower legs by 15% -- or about 2.2 inches.  I could live with that especially if it was possible that I could lengthen my femurs at a later date.

I was fortunate to get 3.5 inches on my lower legs.  I never hoped for that much gain.  Now that I have it, I would not consider the trauma and disruption of additional surgery to get the other 1.5 inches about which I fantasized.  If I feel I need to be taller, there are many shoe manufacturers who can very comfortably give me another 1.5 inches.

So, my bottom line is that unless you are willing to work for 15-20% of gain; then, there are other much easier and much less costly avenues to investigate rather than subjecting your body to the trauma and your life to the disruption of surgery.

 

[IwannaBeTaller]

First of all it's a great thing that you managed to go through LL with no serious complications and an overall good outcome. It's also good to know you're satisfied with your height gain, nobody wants to invest that much (money, time and pain) and still be unhappy.

However, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.

[Uphill]

No convincing scientific data yet.
But i do see the trend has changed: before people were more ambitious and aiming at 8+ even 10+ cm lengthening in one segment; recently more and more folks became moe conservative and finished under 7.5cm.
Maybe because Dr. Paley set the tone with his precise/stryde nails which cannot go over 8cm? He himself didn’t explain the compelling research behind it either ( if there is).

[California2]

However, are you worried about long-term consequences? While one part of going beyond 15-20% is potential problems with soft tissue resisting to stretching, another part is the life-long feasibility of the new leg arrangement. What are your thoughts about the possibility of developing osteoarthritis in the long run? I'm just curious about your take because that's not a huge topic of discussion in the community.

Please allow me to address your question in two parts--first, potential problems with soft-tissue resisting stretching:

Foremost, soft-tissue presents more of a short-term rather than a long-term problem.  By this I mean the damage usually gets done during distraction because a certain soft-tissue cannot stretch the same amount as that moment's distraction.  As a result, something tears or ruptures or announces great pain, etc.

In contrast, once you stop distracting, soft-tissue has the rest of your life to catch up.

It is important to understand what happens when you distract.  Nerves can grow up to 1 mm per day so folks who distract up to 1 mm generally need not worry about nerve damage.  Muscle tissue, tendons, ligaments, blood vessels, and skin is another matter.

Muscle, tendons, and ligaments fight back against distraction.  It is hard to hurt these tissues because they are very tough.  Blood vessels and skin stretch.  To me, a ruptured blood vessel poses the greatest risk; yet, skin at the pin sites seems to present the most common problem.

On my 35 day photo, you can see two wounds, one on each of my lower shins.  These wounds were each pin sites.  As I distracted past 6 cm, my skin refused to keep up at these pin sites.  As a result, the skin started to open up below each pin--like an old-fashioned keyhole.  This type of wound is common.  I had to keep a very close eye on these wounds to ensure each remained within the realm of acceptable risk.

I wrote repeatedly that I believe you must listen to your body as you go through the process.  Wounds such as mine are precisely the type of thing I am writing about--if they became only a little bit worse, I would have had to stop distraction before I reached my goal.

On your second point--osteoarthritis.  I am aware of no connection between limb lengthening and osteoarthritis.  Osteoarthritis is a condition of the joints caused by a breakdown of cartilage in the joints.  Limb-lengthening surgery does not directly involve any joint.

This is not to imply that increased height does not implicate some joints--of course it does.  When you become 3 inches taller, your center-of-gravity changes.  Likewise, the forces on your knee joint as a fulcrum change because the length of the levers acting upon the fulcrum (your femur and tibia) change in relation to one another.

This means that you have to create new muscle memory and become accustomed to your new leg length and center of balance.  A perfect example is that a couple of nights ago I was laying on the sofa with my foot up on the sofa arm.  I pulled my leg back so that my foot would drop onto the sofa cushion--except it didn't. 

My mind understood that my foot should have dropped onto the sofa cushion because my mind was operating from memory of my old leg length.  Now however, I still had 3.5 inches to go before my foot cleared the sofa arm.

In time, new muscle memory will replace the old and I will forget what it was to be my old height.  Likewise, I will use my ankle, knee, and hip joints slightly differently but I don't think these is any reason to believe that I will wear them out any more than I would have before lengthening.

[IwannaBeTaller]

Thanks, California. Soft tissue can indeed adapt quite well to lengthening in many cases, although it takes longer than bone consolidation. Quite a lot of the long-term recoveries after lengthening procedures with little complications we saw in the forum looked good.

As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing.

[California2]

As for the connection between limb lengthening and osteoarthritis, I'm aware of at least two studies studying the connection - one concerning the femur-tibia ratio and another concerning tibia nailing (so not lengthening, but a common part of many LL surgeries) :

The Association of Tibia Femur Ratio and Degenerative Disease of the Spine, Hips, and Knees.
Long-term follow-up of tibial shaft fractures treated with intramedullary nailing.

I reviewed the abstracts of your two studies; however, neither study draws a causal relationship between osteoarthritis and limb lengthening.

The second study above concludes:  "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant."

The primary conclusion is that persons with tibia nails function comparable to the rest of the population.  The study also notes "persistent sequelae which are not insignificant".  "Sequelae" are conditions related to a certain condition--in this study "tibial shaft fracture treated with locked intramedullary nailing".

"Not insignificant" means the conditions were noted but no causal relationship or even a correlation was found.  Moreover, no comparison was made to the population in general.  Finally, the study group are trauma patients and not elective limb lengthening patients.

In summary, I do not conclude based on the second study that elective limb lengthening increases the likelihood of developing osteoarthritis.

The first study consists solely of analysis of cadaver bones.  Limb lengthening is again not a part of the study.  Based on the measurement of 1152 cadaver femurs and tibias, the authors conclude that a tibia should be 80% the length of a femur; and, that if a femur/tibia ratio is otherwise, arthritis may develop.

There is much wrong with this study.  Foremost is the failure to identify the ethnic mix of cadavers studied.  Second is the conclusion that an 80% ratio is the magic number--many studies suggest otherwise.  Last is the conclusion that a variance from the magic number of 80% caused arthritis.  There are, in my opinion, simply too many potential causes of arthritis to assert from a cadaver study that limb ratio is the culprit.

To get good information about increased risk for osteoarthritis in limb lengthening patients, you would need a longitudinal study of such patients and a fixed control group of similarly situated persons without limb lengthening surgery.

Moreover, I do not see a good reason to worry about development of osteoarthritis because osteoarthritis is a joint condition.  Joints are no directly implicated in limb lengthening.  So, to answer your question directly, no I am not worried about developing osteoarthritis caused by limb lengthening in later life.

[HeightGain]

The first study is always rolled out in this site and is not useful. It identifies correlation, no causation and does not look at confounders.

Intramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.

[IwannaBeTaller]

Intramedullary tibial nailing is renowned as having long term complications, knee pain being the most obvious. If they are trauma, no lengthening will be happening. All that study has in common with this is that it is tibia surgery.

Since intramedullary rods are used in internal lengthening, it's very relevant to look at complication and long-term studies regarding intramedullary rods. The complications (such as knee pain you mentioned) can occur after accidents and after LL surgery alike.

[California2]

With respect, I do not agree with the above statements made by either IWannaBeTaller or HeightChange.

First "intramedullary rods" are the nails used in LON and LATN.  They are usually left inside the bone for life although the screws are often removed once the bone heals.

Consequently, intramedullary rods are encountered in external lengthening; not internal. 

Next, such rods are NOT renown for long-term complications.  To the contrary, very few complications attributable to intramedullary rods are known to occur.

In fact, one of the studies referenced plainly concludes "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".

[HeightGain]

A number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.

Earlier you mentioned about long leg films. These should be found in the majority of radiological departments in the US or Western Europe.

[California2]

A number of doctors have told me that about 50% of patients experience long term knee pain. Studies support this. For such key decisions that could potentially affect patients for the rest of their lives they need to be fully informed.

If you believe reliable studies support your contention that use of intermedullary rods to treat tibia fractures causes long-tern knee pain; then, please present those studies.

I showed you using the study you discussed that just the opposite was concluded; namely,  "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".

I agree it is important to be informed; however, it is more important to be accurately informed.

[California2]

45 Days of Consolidation

[ok]

Thanks for posting the x-rays California.

It doesn't seem to be happening extremely fast, but it does seem to be filling up!

A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.

This is just a general question that came to my mind looking at some patients' x-rays.

Cheers!

[InFullStryde]

Thanks for posting the x-rays California.

It doesn't seem to be happening extremely fast, but it does seem to be filling up!

A question that came across my mind, why don't LLers reduce distraction rate when it clear that there is no risk of preconsolidation? It seems to me that in your case, there was no risk of preconsolidation so could you have gone at 0.5mm per day or taken lots of breaks in between? One of the scary aspects of LL is the lengthening and logic seems to suggest that slower rate of lengthening would be friendlier to the body in all aspects.

This is just a general question that came to my mind looking at some patients' x-rays.

Cheers!

Great question.

[California2]

I think you are absolutely correct about slowing the distraction rate.  So long as the fibula is captured, there is no pre-consolidation risk.

In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success.  That patient did pure-externals over the course of one year.  He distracted .5 mm per day up to 9 mm.

For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work.  But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably. 

In hindsight, I probably should have reconsidered my deadline at the start.  Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.

[InFullStryde]

I think you are absolutely correct about slowing the distraction rate.  So long as the fibula is captured, there is no pre-consolidation risk.

In fact, Dr. Kulesh shared the story of a patient who did just what you suggest with great success.  That patient did pure-externals over the course of one year.  He distracted .5 mm per day up to 9 mm.

For me, I set an arbitrary deadline by which I must stop distracting so that I could return home and to work.  But for my self-imposed deadline, I could have gone more slowly, more safely, and more comfortably. 

In hindsight, I probably should have reconsidered my deadline at the start.  Unfortunately, once I learned that I could go more slowly with less risk, I already made commitments to others and had my distraction goal in mind so slowing down meant I had to either miss my goal or break commitments--I elected to push to hit my goal while keeping my promises to others.

I am in similar situation, California.  I want to be up and moving again by June, so do not want to delay to much.  Thank you for your detailed updates.

[myloginacc]

It is important to understand what happens when you distract.  Nerves can grow up to 1 mm per day so folks who distract up to 1 mm generally need not worry about nerve damage.  Muscle tissue, tendons, ligaments, blood vessels, and skin is another matter.

Muscle, tendons, and ligaments fight back against distraction.  It is hard to hurt these tissues because they are very tough.  Blood vessels and skin stretch.  To me, a ruptured blood vessel poses the greatest risk; yet, skin at the pin sites seems to present the most common problem.

Hey, California2 - thanks for all the answers and the patience.

We get almost no threads on the effects of LL on blood vessels. Did Dr. Solomin and Kulesh provide any insight into that issue?

Likewise, you can stimulate arteriogenesis and angiogenesis with exercise.

https://en.wikipedia.org/wiki/Arteriogenesis
https://en.wikipedia.org/wiki/Angiogenesis

Do you happen to know if the doctors recommend exercise for that purpose, after recovery?

Thanks again.

[California2]

From my experience, Professor Solomin and Dr. Kulesh keep a careful eye on vascular issues; however, if they suspect such an issue has arisen, they coordinate a consultation with a vascular specialist.

You ask if one can stimulate an increase in blood vessel size (diameter) or grow more blood vessels with exercise.  If you want a professional opinion; then, I encourage you to interface with a vascular specialist.

Blood vessels grow but they grow like branches on a tree.  When your body determines an area is not adequately serviced by existing vessels, your body releases chemicals that cause a new vessel to sprout.

Blood vessels also constrict and dilate according to a body's needs.  Additionally, medication can be prescribed that cause vessels to constrict and dilate too.

Exercise causes vessels to dilate so that the vessels can carry more blood to the effected muscle.  Once the need for more blood passes, the vessel constricts to its normal size again.  This is all part of the action of the autonomic nervous system that regulates body functions including blood pressure.

So, can you create a permanent change in blood vessel diameter or cause additional vessels to sprout via exercise?  I can only observe that when I used to pump much iron, it was common to see, for example, the vessel in my bicep stand-out all the time or see new vessels in my forearm.

Did I cause my blood vessel diameter to increase semi-permanently?  I suspect that I was leaner so my existing vessels became more visible and working out caused intentional trauma that my body addressed by, in part, increasing blood supply to the area.  However, maybe additional muscle tissue demands more blood; ergo, larger vessels.

As for LL, no doubt exists that persons with more muscle mass at the lengthening site will consolidate more quickly; however, it would be pretty challenging to increase muscle mass at the lengthening site during lengthening.

Please let me know if you come upon any research on point.

[zlRadamanthys]

Hello California, I have followed your little journal carefully and I want to know your opinion about solomin and kulesh doctors. I'm from South America I do not know how the medical visa process is, I can go without a visa but only for 90 days which is insufficient. My point is that I have very little muscle mass in my calves, almost nothing and they are constantly hurting me because of the distances I walk. I have a sitting height of only 85 cm and I measure 169 cm at night. I wanted to know if there is any problem with having the calves so thin and if I could aspire to lengthen to 6.5 cm without the ATL launch. And what method would you recommend me with your respective recovery time. Finally, why part of the knee insert the nail. It would be a great favor if you answer these questions friend and luck in your recovery

[TemakiSushi]

If you believe reliable studies support your contention that use of intermedullary rods to treat tibia fractures causes long-tern knee pain; then, please present those studies.

I showed you using the study you discussed that just the opposite was concluded; namely,  "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms...".
only 15 (26.7%) denied knee pain with any activity whereas 41 patients (73.2%) had at least moderate knee pain. With respect to swelling, 19 (33.9%) reported asymmetrical swelling affecting the injured limb. However, of the 33 physically examined patients, only 6 (18.2%) had objective evidence of venous stasis.
I agree it is important to be informed; however, it is more important to be accurately informed.

Why do you omit this part from the study mentioned above:

At a median 14 years after tibial nailing of isolated tibial fractures,
patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant.


only 15 (26.7%) denied knee pain with any activity whereas 41 patients (73.2%) had at least moderate knee pain. [/b]With respect to swelling, 19 (33.9%) reported asymmetrical swelling affecting the injured limb. However, of the 33 physically examined patients, only 6 (18.2%) had objective evidence of venous stasis.

https://www.ncbi.nlm.nih.gov/m/pubmed/18758282/

[notatroll]

TemakiSushi is right. People only want to hear positive things. They hide the negative aspects and create a false depiction of reality. LL is hard. LL sucks. LL creates permanent sequelae. BUT people want LL so badly that they don't want to hear that.

[California2]

To TemakiSushi:

It appears you are reading a study but you do not understand what you are reading.

When a research conclusion notifies you that "objective and subjective evaluation shows persistent sequelae which are not insignificant"; this means that the study observed other things but could not draw any valid conclusions about these other things.

You point out certain factual complaints made by members of the study; then, ask why I don't focus on such points.

I do not focus on such points because these points were NOT studied. 

The objective of the study is:  "We conducted a study to evaluate the long-term functional outcomes of patients with an isolated tibial shaft fracture treated with locked intramedullary nailing."

The conclusion of the study is: "At a median 14 years after tibial nailing of isolated tibial fractures, patients' function is comparable to population norms, but objective and subjective evaluation shows persistent sequelae which are not insignificant."

You want to ascribe meaning to survey reports such as "41 patients (73.2%) had at least moderate knee pain". 

Unfortunately, this study did not look into a comparison of reports of knee pain from people who have a tibia repaired with an intramedullary nail as compared to knee pain in persons without tibia repair or any other condition you are trying to deem "significant". 

Instead, the study looked at what it looked at and concluded what it concluded.

If you locate a study that actually looks at LL recovery issues as compared to similar issues in a non-LL control group; then, please share it.  So far as I know, no such study exists.

[California2]

Hello California, I have followed your little journal carefully and I want to know your opinion about solomin and kulesh doctors. I'm from South America I do not know how the medical visa process is, I can go without a visa but only for 90 days which is insufficient. My point is that I have very little muscle mass in my calves, almost nothing and they are constantly hurting me because of the distances I walk. I have a sitting height of only 85 cm and I measure 169 cm at night. I wanted to know if there is any problem with having the calves so thin and if I could aspire to lengthen to 6.5 cm without the ATL launch. And what method would you recommend me with your respective recovery time. Finally, why part of the knee insert the nail. It would be a great favor if you answer these questions friend and luck in your recovery

To zlRadamanthys:

I have the highest regard for professor Solomin and Dr. Kulesh; however, you should form your own opinion.

You have not thought through your Visa issues.  No Visa is required for tourists from South Africa who stay less than 90 days.  However, tourist Visas up to 3 years in duration are available.  Consequently, should you go the free route but visit Estonia after 89 days; then, return to Russia for another 90 days; or, should you apply for a longer Visa?

I suspect pretty much anyone can lengthen legs.  Whether you are recommended to do so; and if so, how, is another matter.

If you want to lengthen your tibias; then, it is helpful to develop some muscle mass in your calves before surgery.  However, even though the calf side of the tibia consolidates faster, the front side still consolidates.

If you can afford internal lengthening; then, get it.  Internal lengthening is an easier process. 

If you prefer to spend 1/3 to 1/5 the cost of internal lengthening; or, if you have a bone irregularity to correct in addition to lengthening; then, get external.

If you have the time and patience to do purely external; then, this is the safest and surest route.  If you prefer to get rid of the rings for consolidation; then, LATN is generally recommended over LON because LATN accommodates the use of a larger nail for consolidation (which is more stable).

Notwithstanding the above, what you choose to do, if anything, and how you choose to do it should be the result of your desires, your budget, and your informed and detailed conversation with your surgeon.

Last, for either LON or LATN, an incision (about 2") is made over the kneecap.  The kneecap is pushed aside to expose the top of the tibia.  A hole slightly larger than the nail is drilled/reamed and the nail is inserted.  Holes may be drilled laterally in the tibia to allow discharge of reamed fat and bone.

If LON, the tibia is cut before the nail is inserted but the nail is not fixed.  In LATN, the nail is fixed upon insertion.

I think most anyone can successfully lengthen.  However, I also think that most people do NOT critically think about things and process information so as to be successful.  If you are disciplined and understand what will be required of you for your situation; then, so long as you do what is required of you for your situation, you will likely be successful.

[zlRadamanthys]

Very thanks for your infortaion. I hope you are fine, i respect you. Excuse me my english but my native lenguaje is spanish. I want know if y could send a pm, to do my questions, Thanks u man

[California2]

If you have questions, please just post them.  Others likely have similar questions.  I don't look at this bulletin board very often and someone else may want to respond to your questions.

[zlRadamanthys]

Well I would like to know its size, also its size of duck and finally what is the length of your forearm. It would be of great help for me these answers, I hope you have a maximum recovery and my best wishes with you

[myloginacc]

Hey, California2. I'm back with some extra questions, if you don't mind.

Most people have a slight limb length discrepancy (LLD). Did you have it, and if so, do you remember by how much? How did Dr. Solomin and Kulesh take that into account during your lengthening?

How was the PT during your lengthening?

[LLwarrior]

Hey California , what is the expected time to be walking unnaided after nail insertion ? are you walking now with crutches ?